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General NPI Number Information
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NPI Number | 1184078313
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Entity Type | Organization
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Legal Business Name | NEW LEAF ACUPUNCTURE CLINIC LLC
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Dates
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Enumeration Date | 04/13/2016
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Last Update Date | 04/13/2016
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Provider Practice Location Address
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Address Line | 3932 JOHN F KENNEDY PKWY SUITE F
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City | FORT COLLINS
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State | CO
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Zip | 80525-3084
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Country | US
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Telephone | 970-568-8095
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Fax |
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Provider Business Mailing Address
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Address Line | 3932 JOHN F KENNEDY PKWY SUITE F
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City | FORT COLLINS
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State | CO
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Zip | 80525-3084
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Country | US
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Telephone | 970-568-8095
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Fax |
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Authorized Official
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Title or Position | LICENSED ACUPUNCTURIST
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Name | MEGAN HARMS
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Credential | LAC., MSOM
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Telephone | 970-889-2221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 1982
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License Number State | CO
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